Provider Demographics
NPI:1801838644
Name:JONES, MOJGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7301
Mailing Address - Country:US
Mailing Address - Phone:910-762-4600
Mailing Address - Fax:
Practice Address - Street 1:1602 PHYSICIANS DR STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7350
Practice Address - Country:US
Practice Address - Phone:910-442-1200
Practice Address - Fax:910-442-1299
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001697363A00000X
NC0010-01546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP85984Medicare UPIN